Provider Demographics
NPI:1588234082
Name:JOLLOTTA, JAIMIE ANN (RDH)
Entity Type:Individual
Prefix:MISS
First Name:JAIMIE
Middle Name:ANN
Last Name:JOLLOTTA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S POND RD
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-0406
Mailing Address - Country:US
Mailing Address - Phone:207-649-2298
Mailing Address - Fax:
Practice Address - Street 1:185 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6625
Practice Address - Country:US
Practice Address - Phone:207-649-2298
Practice Address - Fax:207-872-6888
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3588124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist